Ten Years of Laparoscopic Pectopexy: A Case Series Analysis

TL;DR

This study analyzes 10 years of laparoscopic pectopexy outcomes, finding most failures occur within 4 years and addressing lateral defects improves long-term success.

Contribution

The study provides long-term outcome data for laparoscopic pectopexy and identifies lateral defect severity as the strongest predictor of failure.

Findings

Median recurrence-free survival was 9.34 years and reoperation-free survival was 9.56 years.

Apical re-fixation achieved a 94.9% long-term success rate over 10 years.

Lateral defect severity was the strongest predictor of failure (p < 0.001).

Abstract

Pelvic organ prolapse (POP) often causes significant urinary, bowel, pain, and sexual symptoms, and treatment success is increasingly defined by symptom relief rather than anatomical correction alone. Long-term outcome data for laparoscopic pectopexy (LP) remain limited.

We conducted a retrospective cohort study of all women undergoing multicompartment POP repair with LP and native tissue repair of level 2 and 3 defects at a tertiary referral center between 2010 and 2019. The primary outcome was prolapse recurrence, defined as POP-Q stage II or higher. Secondary outcomes included de novo POP, surgical reoperation, and complications. Time-to-event outcomes were analyzed with Kaplan–Meier survival curves to estimate freedom from recurrence and freedom from reoperation.

A total of 832 patients were included (median age of 63 years). Median recurrence-free survival was 9.34 years (IQR 7.36–10.60), and median reoperation-free survival was 9.56 years (IQR 7.68–10.71). Most events (87.9%) occurred within 4 years. Surgical reoperation was required in 81 patients (9.7%), also clustering in the first 4 years. Apical re-fixation achieved a 94.9% long-term success rate over 10 years. Logistic regression identified lateral defect severity as the strongest predictor of failure (p < 0.001), whereas demographic factors and prior surgery had minimal impact.

LP with defect-oriented native tissue repair provides durable apical support with a low 10-year reoperation rate. Most clinically relevant failures occur within 4 years, supporting follow-up of this duration. Addressing lateral defects during initial surgery is critical for optimizing long-term outcomes.

The online version contains supplementary material available at 10.1007/s00192-025-06377-7.

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